Leprosy Post-Exposure Prophylaxis Project

Partnership objectives

The overall aim of the Leprosy Post-Exposure Prophylaxis (LPEP) program is to evaluate the feasibility and efficiency of contact tracing and the provision of preventative treatment for leprosy under routine conditions in several countries, and to determine the impact this has on leprosy incidence. The ultimate goal of the LPEP program is to document and integrate the evidence generated and lessons learned into national leprosy policy to ensure widespread implementation.

The LPEP project has four goals:

  1. The integration of Post-Exposure Prophylaxis (PEP) experiences and lessons learnt into national leprosy programs.
  2. The development of guidelines for PEP and contact management.
  3. The creation of nationally scalable surveillance systems including active contact tracing and PEP.
  4. The documentation of the cost implication of this new strategy for national leprosy programs.

Although leprosy is often considered to be a disease of biblical times, it still affects many people. Although leprosy is often considered to be a disease of biblical times, it still affects many people. Copyright Novartis Foundation for Sustainable Development

What are the health needs and challenges?

Leprosy is an infectious disease caused by Mycobacterium leprae, bacteria that multiply very slowly. Once infected, the average incubation period is two to three years, although it can take between 6 months and 40 years for symptoms to appear. Leprosy is not highly infectious and although its transmission is not fully understood, close and frequent contact with an infectious patient accelerates transmission. Disabilities are secondary complications which result from late diagnosis when the insensitivity (nerve damage) caused by leprosy is already present. Multidrug therapy (MDT), the WHO-recommended treatment, consists of three drugs (dapsone, rifampicin and clofazimine), of which the latter two were developed in the research laboratories of Novartis. MDT has made it possible to treat patients, reduce the transmission of leprosy and prevent disabilities. Even patients with the severest form of the disease show visible clinical improvement within weeks of starting treatment.

Since 2000, Novartis has been providing MDT free of charge to all leprosy patients through the WHO, donating more than 56 million blister packs valued at over USD 90 million, helping to treat over 6 million leprosy patients worldwide. In 2015, as part of its commitment to the London Declaration on Neglected Tropical Diseases (NTDs), Novartis announced the extension of this MDT donation through to 2020. This five-year agreement includes treatments worth more than USD 40 million and up to USD 2.5 million to support the WHO in handling the donation and logistics. Overall it is expected that the program will reach an estimated 1.3 million patients during the next five years.

Since 1981, more than 16 million leprosy patients have been treated thanks to the widespread availability of MDT, reducing the global burden by 95% - a real public health success story. In recent years, however, leprosy elimination efforts have become a victim of their own success: with fewer patients detected, funding and political commitment as well as knowledge of the disease has declined. The case detection rate for leprosy has plateaued at about 200,000–250,000 over the past ten years, and the disease remains endemic in many countries in Asia, Africa and Latin America; even countries with low overall endemicity may have localized high-burden pockets. As a result, the remaining challenge now is to interrupt transmission.

Description of partnership activities and how they address needs and challenges

In 2013 the Novartis Foundation launched a new leprosy strategy that focuses on interrupting transmission, to support the last mile in the ultimate goal of leprosy elimination. This strategy is based on consensus reached by a group of leading leprosy and disease elimination experts, who agree that a successful program requires early diagnosis and prompt treatment for all patients, tracing (also known as active screening) and post-exposure prophylaxis (PEP) for contact persons of patients newly diagnosed with leprosy, development of new diagnostic tools, as well as strict epidemiological surveillance and response systems to monitor progress. The aim of this strategy is to demonstrate that the annual number of newly diagnosed leprosy patients can be further reduced.

To implement this strategy, in June 2014, the Novartis Foundation collaborated with several International Federation of Anti-Leprosy Associations (ILEP) members: Netherlands Leprosy Relief, FAIRMED, American Leprosy Missions and the German Leprosy and TB Relief Association , along with Swiss TPH and Erasmus University in the Netherlands and national leprosy control programs to introduce PEP in several pilot countries across Asia, Africa and Latin America with the purpose of reducing the risk to develop leprosy in contact persons of newly diagnosed patients.

The LPEP program has been introduced in Indonesia, India, Nepal, Myanmar, Tanzania, Sri Lanka, Brazil and Cambodia. LPEP will run until 2018 for all countries, except Cambodia, which is set to finish in 2019. Once a new patient has been diagnosed, health services actively screen household members and neighbors of the patient and examine them. Symptomatic persons are promptly referred for multidrug therapy (MDT) and asymptomatic contact persons are offered a post-exposure prophylaxis (single dose rifampicin), to reduce their risk of developing leprosy by 50-60%. This active contact tracing of newly diagnosed patients is a targeted strategy to prevent leprosy and to accelerate diagnosis and prompt treatment among those most at risk. 

The LPEP program will build knowledge on the most effective and feasible approach to operationalize PEP and on its potential to impact disease transmission. It has also been included in the revised World Health Organization (WHO) Global Leprosy Elimination Strategy 2016–2020.

The LPEP research protocol has published in BMJ Open.


Why should leprosy be in the spotlight?

Ann Aerts on leprosy and the Novartis Foundation's strategy to eliminate the disease

Life after Leprosy in Cambodia

Partnership information

Company(ies) Novartis

Partner(s) Erasmus University, International Federation of Anti-Leprosy Associations, Netherlands Leprosy Relief, Swiss Tropical and Public Health Institute (Swiss TPH)

Type of Partner(s) Academia / Hospitals, NGOs, Professional Associations

Therapeutic Focus Neglected Tropical Diseases

Disease(s) Leprosy

Program Type(s) Availability of Treatment - Product Donations, Health System Infrastructure - Outreach & Medical Services, Health System Infrastructure - Training, Prevention Programs - Awareness & Outreach

Targeted Population(s) Children, Elderly, Health professionals, Marginalised / Indigenous People, Men, Patients in needs of treatment, People with low income, Women

Region(s) East Asia & Pacific

Number of Countries 1

Country(ies) Cambodia

Start Date 2014

More information Novartis Foundation for Sustainable Development

Anticipated completion date Ongoing